Declaration Form

To be permitted inside the campus the parent and student is required sign and submit
this Declaration Form (please put a tick against your responses)

 In the past 14 days, you have not come into close contact (within 6 feet) with
someone who has tested positive for COVID-19 or is presumed to have COVID-19.
YES /NO
 You do not have COVID-19 or reason to believe you have COVID-19. Symptoms
include cough, fever, chills, and muscle pain, shortness of breath or difficulty in
breathing, sore throat, and loss of taste or smell.
YES/NO
 To your knowledge, you are not violating any travel restrictions or quarantining
requirements.
YES/NO
 You agree to wear a mask the entire time you are at College and will follow
all instructions from the college staff.
AGREE/DISAGREE
 As a college, we have taken all measures specified by the Ministry of Home and
Family Welfare and creates a safe environment; however, it is not possible to entirely
remove the risk of exposure to COVID-19.
AGREE/DISAGREE
 You are not coming from any containment zones.
YES/NO
 In case you or your family member experience symptoms of COVID or are tested
positive, the college will be informed at the earliest.
YES/NO

Please Note: The decision of the Principal in this regard is final and must be respected.
This form will have to be re-submitted if a student is returning to college after a break
of 2-3 days.

Name of student: Name of Parent /Guardian:

Signature: Signature of Parent /Guardian:

Class: Phone no of Parent/ Guardian:

Date: